Multicomponent strategies needed to prevent in-hospital delirium

By Sarah Guy, medwireNews Reporter

Delirium in hospitalized adult patients indicates poor long-term outcomes and should be identified promptly and dealt with using evidence-based multicomponent strategies, suggest the authors of a systematic review.

The findings, gleaned from 38 published systematic evidence reviews, reveal various risk factors for developing the condition, including age, cognitive impairment, depression, and mepiridine use for analgesia.

Furthermore, delirium caries a poor prognosis with an increased risk for death, institutionalization, and dementia, write Babar Khan (Indiana University Center for Aging Research, Indianapolis, USA) and colleagues in the Journal of Hospital Medicine.

"We need to develop better mechanisms for diagnosing delirium so that prompt treatment regimens can be initiated," said co-author Chris Fox (University of East Anglia, Norfolk, UK) in a press statement.

The research team reports that interventions such as early mobilization, preventing sleep deprivation, minimizing use of psychoactive drugs, and use of eye glasses and hearing aids can help prevent delirium developing in at-risk elderly populations, with a 40% reduction in delirium incidence at the institution that employed this specific intervention.

Indeed, one of six relevant studies reviewed showed that age above 64 years and preoperative cognitive impairment increased the risk for developing delirium in elective vascular surgery patients.

Other risk factors identified in the review included depression, needing intraoperative blood transfusions, use of mepiridine in elderly surgical patients, and use of anticholinergic drugs in medical and surgical patients in intensive care units.

"Delirium is extremely common among older adults in intensive care units and is not uncommon in other hospital units and in nursing homes, but too often it is ignored or accepted as inevitable," said Khan in the press statement.

The authors report that the Confusion Assessment Method (reviewed in 25 prospective studies) was the most useful bedside tool for diagnosing delirium, with an overall positive likelihood ratio of 9.6.

Among the six trials examined that investigated pharmacologic prevention of delirium, low-dose haloperidol prophylaxis reduced the severity of delirium (mean difference of 4 points in the delirium rating scale score), as well as the duration, shortening patients' hospital stays by a mean 5.5 days.

However, the authors suggest that use of pharmacotherapy in delirium prevention needs to be explored further with a "large randomized trial to compare haloperidol with atypical antipsychotics" warranted.

"Delirium among hospitalized patients is a common syndrome with a significant burden to the healthcare system and society," conclude Khan et al.

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